Wayne State students develop electronic medical record used by international missions

Medical teams on international missions use the program to track patient care

Since 2014, dozens of Wayne State medical, pharmacy and nursing students have traveled to Haiti and the Dominican Republic

fEMR is a free and open-source software system

Sarah Draugelis

Nabil Othman (left) at a clinic in Haiti during 2014 as a medical student at Wayne State University.

Developed in 2011, Team fEMR is now used by at least five medical relief organizations to aid continuity of care.

When Nabil Othman, M.D., was a third-year medical student at Wayne State University School of Medicine, he took a trip to Haiti in 2014 with 19 of his closest friends.

But it wasn't a vacation. He was on an international medical mission, one he later said gave him a deeper appreciation of his field.

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Sarah Draugelis, president, Team fEMR

But Othman was also testing a newly invented electronic medical record system for traveling medical teams. Co-developed in 2011 by Sarah Draugelis and two of her WSU classmates, Team fEMR is now used by at least five medical relief organizations, including doctors and students at Wayne State with the World Health Student Organization and International Samaritans of Ann Arbor.

"We used fEMR twice in a mountainous community outside Port-au-Prince, once in February and once in December" 2014, said Othman, who grew up in Detroit and now is a second-year anesthesiology resident at Cedars-Sinai Medical Center in Los Angeles.

Othman said the experience he and other medical, pharmacy and nursing students had with Wayne State doctors was "fantastic." He said each visit was for a week, and the team treated nearly 500 people.

"When I was in medical school, I wanted hands-on experience. We were studying all year long, and I wanted to do something," he said. "We set up a primary care clinic there and used fEMR to do all the charting."

Draugelis said fEMR has logged more than 30,000 patient records the last four years from trips to Haiti, Peru, the Dominican Republic, India and Ecuador. Besides Wayne State, Florida State University, Louisiana State University and University of Toledo also use fEMR, she said.

"I began this work when I was a student at Wayne State after noticing a lack of continuity in medical volunteers after the 2010 earthquake in Haiti," said Draugelis, a premedical student at Wayne State who graduated with a psychology degree. She also is a professional ballerina performing in Detroit and Chicago.

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Sarah Draugelis

Kevin Zurek, a computer science graduate who works now at Ford Motor Co, is a co-founder of Team fEMR.

The fEMR program is free, open-source software that can be downloaded by anyone, Draugelis said. The co-founders also include Kevin Zurek, a computer science graduate who works now at Ford Motor Co.; and Erik Brown, a neurosurgery resident in Portland, Ore., who also was in Wayne's M.D.-Ph.D program.

The current chair of Team fEMR is Chih Chuang, M.D., a WSU professor of medicine and palliative care specialist at John D. Dingell VA Medical Center in Detroit. He will be succeeded in July by Justin Hickman, M.D.

Chuang said Wayne State students continue to participate with WHSO and go on medical missions, now focusing on public health. However, due to unrest in Nicaragua, WHSO has shifted more to Haiti and the Dominican Republic. He said Wayne students have already gone this year and are planning a return in 2019.

"Volunteer doctors and nurses take a suitcase filled with the laptop and the software loaded. They use the laptop as an intranet server and can connect with iPhones or other laptops. This allows them to work in remote areas and take care of patients," said Draugelis, who went on medical missions in 2011 and 2012 during the testing phase of fEMR.

For repeat medical missions, Draugelis said the patient records help doctors track medical care and also know what supplies to bring. "In Haiti, if we knew there were a number of high-risk pregnancies, we could have brought extra kits and supplies," she said.

Mohammed Arsiwala, M.D., an internist who often goes on international medical missions to Africa, said he is familiar with fEMR and knows doctors who have used it.

"It is very effective. Wayne State uses it, and it can benefit you if you work in an area that doesn't have Wi-Fi and you can work off a laptop and log visits," said Arsiwala, president of Michigan Urgent Care Centers and president-elect of the Michigan State Medical Society.

But Arsiwala, who also operates a charity, the H.E.L.P Foundation, said he has his own methodology for recording patient visits. He often travels on medical missions with his wife, Tara Coughlin, who also has a medical foundation, Malayka International.

"I was in Africa (last month) and I do registration manually. I write things down. Every day 500 to 600 people show up. They don't have a photo ID, and I can't log all the information into an EMR," Arsiwala said.

In Haiti, Othman found that many of the Haitians had common and recurring primary care problems, including hypertension, diabetes and reflux disease. But there were patients with HIV, breast cancer and advanced mitral valve disease.

"We saw a lot of worm infections and gastrointestinal problems," he said.

One of the benefits of fEMR was continuity of care, Othman said. For several years, Wayne students, doctors and nurses visited the same community and saw the same patients.

"We went back year after year at scheduled times. We thought we would use fEMR to hold community's medical record. It worked very well for four years," he said. "I think it demonstrated the value that you can have a medical record without any internet infrastructure."

Othman said students and doctors took medical histories just like in the U.S. "It took 15 to 20 minutes, on par for normal. We got pictures, names, addresses of people, birthdays. We took a full history, present illness, past surgical history, social history, current medications and allergies."

While he said he is enjoying his anesthesia residency at a busy 1,000-bed urban hospital, Othman said he is looking forward to going out on another medical mission.

"I learned from before how really refreshing the experience was," he said. "The people from Haiti or other countries, they don't have the same care we have here in the U.S. They are more grateful and trusting. After all the administrative work and insurance forms, missions are a more pure form of medicine."